Some people without celiac disease report gastrointestinal intolerance to gluten-containing foods. In 2011, Australian researchers conducted a controlled-diet study that boosted the case for “nonceliac gluten sensitivity” (NEJM JW Gen Med Apr 5 2011). Now, the same group has explored whether “FODMAPs” (Fermentable, Oligo-, Di-, Monosaccharides, And Polyols) might confound the perceived response to a gluten-free diet. FODMAPs are fermentable, poorly absorbed, short-chain carbohydrates that include fructose, lactose, fructans (found in wheat), galactans, and polyol sweeteners.

The trial included 37 patients with irritable bowel syndrome who reported gluten sensitivity, and whose evaluations for celiac disease were negative. During a 2-week run-in period, all patients followed a gluten-free, low-FODMAP diet. Then, in a randomized, double-blind, crossover format, each patient received high-gluten, low-gluten, and no-gluten diets (1 week for each diet, separated by 2-week washout periods).

During the low-FODMAP run-in period, mean symptom scores improved significantly. However, symptoms worsened during each of the three double-blind treatments — with no differences between the high-gluten, low-gluten, and no-gluten periods. Twenty-two patients repeated the whole study with 3-day (rather than 7-day) food challenges, and with dairy products and chemical food additives also eliminated from their diets. Again, symptoms worsened just as much with the no-gluten diet as with the gluten-containing diets.

Comment

In this study of nonceliac patients who reported previous gluten sensitivity, a gluten-containing diet was no more likely than a no-gluten diet to worsen symptoms in the presence of a low-FODMAP diet. Because many gluten-containing foods also are high in FODMAPs, the authors speculate that improved symptoms with a gluten-free diet actually might reflect simultaneous reduction in FODMAP intake. However, our understanding of nonceliac gluten sensitivity remains incomplete.

Editor Disclosures at Time of Publication

Disclosures for Allan S. Brett, MD at time of publicationNothing to disclose

Reader Comments (2)

It is a lack of DPP IV enzyme which is responsible for the gluten sensitivity without celiac disease. Melatonine does play a role as well. Exorphines add up over time and brake down the endorphine receptors in the gut. This leads to neurological symptoms and diseases such as migraines, noise intolerance, restless leggs, ear infections, fibromyalgia, immune deficiency in general.

I have non-celiac sensitivity and my symptoms are as you described above, no difference in eating gluten and also the dairy sensitivity.
I believe there is a missing enzyme and I am checking that out.
Every person I encounter has it in their family; it's an epidemic.
Histamine is definitely involved and I believe that is where the missing enzyme comes in. I will never stop in my search to seek answers and help people who are living in misery with this disorder.

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